Recovery from endotoxin shock after extracorporeal perfusion without anticoagulation

The purpose of this study was to determine the effect of an extracorporeal nonanticoagulated perfusion system on survival from endotoxin shock in anesthetized closed-chest dogs. Dogs weighing approximately 18 kg were perfused four hours or used as nonperfused controls. In the perfused animals, blood was diverted from the distal aorta via plastic tubing at 1,000 ml/min into a reservoir and returned by means of a roller-type pump to the femoral veins. Whole blood clotting times increased from a control value of seven minutes to greater than 24 hours within 45 minutes of perfusion in the absence of exogenous anticoagulation. After blood became incoagulable, animals were infused with 3 mg/kg Escherichia coli endotoxin during a 30-minute period. Systemic pressures declined during the initial period but returned to base-line values; glucose remained at normal levels and all six dogs thus treated remained healthy survivors after seven days. On the other hand, animals infused with endotoxin without extracorporeal perfusion demonstrated hypotension, hypoglycemia, and diarrhea, and five of six dogs died within 36 hours.